Edith Holsboer-Trachsler

Universität Basel, Bâle, Basel-City, Switzerland

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Publications (208)534.25 Total impact

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    Nadeem Kalak, Sakari Lemola, Serge Brand, Edith Holsboer-Trachsler, Alexander Grob
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    ABSTRACT: Background: Adolescents’ sleep duration and subjective psychological well-being are related. However, few studies have examined the relationship between sleep duration and subjective psychological well-being longitudinally across adolescence – a time of profound biological and psychosocial change. The aim of this longitudinal study was to investigate whether shorter sleep duration in adolescents is predictive of lower subjective psychological well-being 6 months and 12 months later or whether lower subjective psychological well-being is predictive of shorter sleep duration. Methods: Adolescents (age range, 10.02–15.99 years; mean age, 13.05±1.49 years; 51.8%, female) from German-speaking Switzerland (n=886) and Norway (n=715) reported their sleep duration and subjective psychological well-being on school days using self-rating questionnaires at baseline (T1), 6 months (T2), and 12 months from baseline (T3). Results: Cross-sectional and longitudinal analyses revealed that sleep duration decreased with age. Longer sleep duration was concurrently associated with better subjective psychological well-being. Crossed-lagged autoregressive longitudinal panel analysis showed that sleep duration prospectively predicted subjective psychological well-being while there was no evidence for the reverse relationship. Conclusion: Sleep duration is predictive of subjective psychological well-being. The findings offer further support for the importance of healthy sleep patterns during adolescence.
    Neuropsychiatric Disease and Treatment 07/2014; 10:1199-1207. · 2.00 Impact Factor
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    ABSTRACT: Sleep problems are a well-known risk factor for work injuries, but less is known about which vulnerable populations are most at risk. The aims of this study were to investigate the association between sleep quality and the risk of work injury and to identify factors that may modify the association. A case-control study including 180 cases and 551 controls was conducted at the University Hospital in Basel, Switzerland, from 1 December 2009 to 30 June 2011. Data on work injuries and sleep quality were collected. Adjusted odds ratios and 95% confidence intervals of the association between sleep quality and work injury were estimated in multivariable logistic regression analyses and were stratified by hypothesized effect modifiers (age, gender, job risk, shift work, sleep duration and working hours). Poor sleep quality was associated significantly with work injury of any type (P < 0.05) and with being caught in particular (P < 0.05). The association between poor sleep quality and work injury was significantly higher for workers older than 30 years (odds ratio>30 1.30 versus odds ratio≤30 0.91, P < 0.01), sleeping 7 h or less per night (odds ratio≤7 1.17 versus odds ratio>7 0.79, P < 0.05) and working 50 h or more per week (odds ratio≥50 1.79 versus odd ratio<50 1.10, P < 0.01). Work injury risk increased with increasing severity of sleep problems (P < 0.05). Prior work injury frequency increased with decreasing sleep quality (P < 0.05). Older age, short sleep duration and long working hours may enhance the risk of work injuries associated with sleep quality.
    Journal of Sleep Research 06/2014; · 3.04 Impact Factor
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    ABSTRACT: Objectives: Postpartum Depression (PPD) implies an impairment of maternal adaptation. Moreover, there is increasing evidence that children of mothers with PPD are at risk for developmental abnormalities, including emotional/behavioural difficulties in later life. The aim of this study was to investigate in the association between maternal psychopathology, mother-infant-relationship and infant irritability three months postpartum. We expected that mothers with PPD would report more parenting stress and more difficulties in postpartum bonding, and that these difficulties would be associated with more infant irritability. Methods: In a prospective study a total of 127 mothers (mean age: 33.3 years; 43% primipara) completed a series of questionnaires related to postpartum depression, sleep quality, parenting stress, maternal sleep quality, postpartum bonding and infant irritability. Of the 127 participants, 21 reported to suffer from PPD. Results: Compared to mothers without PPD, mothers with PPD reported increased parenting stress, delayed postpartum bonding, and higher bonding anxiety. They were more likely to consider their infants as stressors, and they reported more infant irritability. Poor maternal sleep was associated with increased parenting stress and with impaired bonding. Conclusion: The pattern of results suggests that mothers suffering from PPD are at increased risk to report poor sleep, high parenting stress, and difficulties in postpartum bonding, as compared to mothers without PPD. Mothers’ behaviour and infants’ irritability are associated. We claim that treatment of PPD should include support of parental competences, nocturnal sleeping behaviour and mother-infantbonding
    Swiss Society for Child and Adolescent Psychiatry and Psychotherapy, Basel - Switzerland; 06/2014
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    ABSTRACT: Studies of the long-term stability of sleep in pre-schoolers are scarce. The aim of the present study was to investigate objectively assessed sleep via actigraphy in pre-schoolers longitudinally, and to predict sleep, psychological functioning and cortisol secretion prospectively as a function of sleep 12 months earlier. A total of 73 pre-schoolers (mean age: 5.45 years; 53% females) were assessed again after 12 (mean age: 6.4 years). Sleep-actigraphy recordings were performed, saliva cortisol was analysed, and parents and experts rated children's psychological functioning. Longitudinally, poor sleep at age 5.45 years was associated with poor sleep and internalizing and peer problems but not with externalizing problems and hyperactivity, and cortisol secretion 12 months later. At age 6.4 years and cross-sectionally, poor sleep was concurrently associated with greater psychological difficulties and increased cortisol secretion. In pre-schoolers, poor sleep objectively assessed at age five was associated with psychological difficulties and poor sleep as assessed via actigraph and one year later. Results indicate that in pre-schoolers sleep remains stable over a 12-mont interval. Pre-schoolers with poor sleep appear to be at risk for developing further psychological difficulties.
    Journal of Psychiatric Research 04/2014; · 4.09 Impact Factor
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    ABSTRACT: Aims: In educational and vocational settings, people are asked to work in teams. This requires social skills but also promotes time-efficient knowledge enhancement. Aiming to Original Research Article British Journal of Education, Society & Behavioural Science, 4(8): 1029-1037, 2014 1030 support the acquisition of both, many studies investigated new teaching methods for schools, emphasising cooperation and centrality of students in the learning process. However, research in non-western countries on this topic remains scarce. Therefore, the present study wants to investigate the effects of cooperative learning on (a) children’s social skills and (b) knowledge acquisition in a non-western country, Iran. Place and Duration of the Study: The study was conducted in an elementary school in Ilam city (Iran) between October and December 2012. Study Design: One hundred twenty male fifth graders were randomly assigned to intervention and control group. Two raters independently assessed students’ educational attainment in experimental science and social skills before and 2 month after implementation. Methods: Students in the control group learned the text material independently, whereas students in the intervention group were taught cooperatively, using the Jigsaw method. Results: Compared to the control group, the intervention group showed significantly more improvement of social skills over time (F(1,58)=29.37, P<.001, eta2=.34). Though, both groups increased their knowledge, the intervention group achieved a significantly broader and deeper understanding of the topics (F(1,58)=33.27, P<.001, eta2=.365) over time. Conclusions: The results suggest that cooperative learning methods enhance both, social skills and knowledge acquisition at elementary school level in non-western countries such as Iran.
    British Journal of Education, Society, and Behavioural Science. 04/2014; 4(8):1029-1037,.
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    ABSTRACT: Abstract Background: Falling in love is a human universal behavior. Studies indicate that both adolescents and adults experiencing romantic love (RL) emotional states of joy and happiness. However, there is evidence that among adolescents RL also is associated with symptoms of depression and anxiety, but no data on these associations are available for adults. The aim of the present study was therefore to explore the associations between RL, symptoms of depression, anxiety, hypomania and sleep among a sample of Iranian adults. Method: One hundred adults (mean age: 26 years; 53% males) took part in the study. They completed a series of questionnaires related to romantic love, symptoms of depression, anxiety, hypomania, and sleep. Results: An increased state of RL was associated with the bright side of hypomania, stronger symptoms of depression and state anxiety, and better sleep quality. There was no relation to sleep duration. Conclusions: Unlike psychobiological studies assessing highly selected samples of adults happily in love, the present pattern of results shows that in adults, RL is not entirely a joyful and happy period of life. Rather, data suggest that for young adults, falling in love might be a critical life event also associated with uncertainty and unpleasant feelings.
    International Journal of Psychiatry in Clinical Practice 03/2014; · 0.45 Impact Factor
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    ABSTRACT: Objectives. Patients with aneurysmal subarachnoid haemorrhage (aSAH) have impaired sleep and cognitive performance together with more difficulties in social and everyday life. Hypocortisolism has also been reported. However, a study assessing all dimensions between aSAH severity, objective and subjective sleep, cortisol secretion, cognitive performance and social and everyday life has not so far been performed. The aim of the present study was therefore two-fold: (1) to assess, in a sample of patients with aSAH, objective and subjective sleep, cognitive functioning, social skills and cortisol secretion concurrently, and (2) to compare patients on these variables with a control group. Methods. Twenty-one patients (17 females; mean age: 58.80 years) with ruptured aneurysm and surgical intervention and 21 (14 females; mean age: 58.90 years) age- and gender-matched controls took part in the study. Assessments covered objective sleep-EGG recordings, subjective sleep, salivary cortisol analysis, and psychological functioning including memory performance, mood, and emotion recognition. Results. Compared to healthy controls, patients had lower scores for verbal memory performance and emotion recognition; they also reported more marked depressive symptoms and complained of poor sleep. However, no differences were found for objective sleep or cortisol secretion. Subjective and objective sleep, cortisol secretion and psychological functioning were unrelated. Conclusions. Findings indicate that patients with aSAH face psychological rather than physiological issues.
    The World Journal of Biological Psychiatry 02/2014; · 3.57 Impact Factor
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    ABSTRACT: Major depressive disorder has been associated with low serum levels of brain-derived neurotrophic factor (sBDNF), which is functionally involved in neuroplasticity. Although sBDNF levels tend to normalize following psychopathological improvement with antidepressant treatment, it is unclear how closely sBDNF changes are associated with treatment outcome. To examine whether baseline sBDNF or early changes in sBDNF are predictive of response to therapy. Twenty-five patients with major depressive disorder underwent standardized treatment with duloxetine. Severity of depression, measured by the Hamilton Depression Rating Scale, and sBDNF were assessed at baseline, and after 1, 2, and 6 weeks of treatment. Therapy outcome after 6 weeks was defined as response (≥50 % reduction in baseline Hamilton Depression Rating score) and remission (Hamilton Depression Rating score <8). The predictive values for treatment outcome of baseline sBDNF, and early (i.e., ≤2 weeks) changes in sBDNF and Hamilton Depression Rating score were also assessed. At baseline, sBDNF correlated with Hamilton Depression Rating scores. Treatment response was associated with a higher baseline sBDNF concentration, and a greater Hamilton Depression Rating score reduction after 1 and 2 weeks. A greater early rise in sBDNF correlated with a decreased early Hamilton Depression Rating score reduction. Even though higher baseline sBDNF levels are associated with more severe depression, they may reflect an increased capacity to respond to treatment. In contrast, changes in sBDNF over the full course of treatment are not associated with psychopathological improvement.
    Psychopharmacology 02/2014; · 4.06 Impact Factor
  • Serge Brand, Raoul Furlano, Marc Sidler, Jürgen Schulz, Edith Holsboer-Trachsler
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    ABSTRACT: Background: Infants' continuous crying is a challenge both for the child and the principal caregiver. However, the links between infants' sleep, crying and cortisol secretion and mothers' well-being and sleep have been scarcely investigated. The aim of the present study was therefore to examine the link between cortisol secretion, crying and sleep of infants characterized by infantile colic (IC) and mothers' psychological well-being and own sleep. Methods: Mothers of 24 infants characterized by IC (mean age = 8 weeks, SD = 1.5 weeks) completed a series of questionnaires regarding the infant's crying and sleeping patterns. Infants' sleep was objectively assessed with actigraphs. Cortisol secretion was measured by means of saliva samples in the mornings after waking. After 4 weeks, infants were assessed once again. Mothers completed questionnaires assessing their psychological well-being (depressive symptoms, family strain) and sleep. Results: Mothers' psychological well-being and sleep was greatly predicted by infants' morning saliva cortisol levels, sleep disruptions and crying intensity, whereas infants' crying duration and volume had low predictive value. Conclusions: Mothers with infants characterized by IC are at increased risk for reporting impaired sleep, developing depressive symptoms and reporting higher family strain. Most importantly, this risk seems to be greater if their infants' sleep is fragmented. © 2014 S. Karger AG, Basel.
    Neuropsychobiology 01/2014; 69(1):39-51. · 2.37 Impact Factor
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    ABSTRACT: Work-related stress can lead to various health problems ranging from job-related exhaustion to psychiatric and somatic diseases. Biomarkers of job-related exhaustion could help to improve our understanding of the biological mechanisms and might be useful to guide prevention and treatment strategies. The present study included 12 male cases suffering from job-related exhaustion and 12 matched healthy controls. Severity of exhaustion was assessed with the Maslach Burnout Inventory (MBI) and the Shirom-Melamed Burnout Measure (SMBM). Whole genome expression profiles derived from whole blood cells (baseline and following glucocorticoid-receptor (GR) stimulation with 1.5 mg dexamethasone p.o.) and corresponding plasma cortisol levels were analyzed. All cases participated in regular aerobic exercise for 12 consecutive weeks and were then re-assessed at follow-up for exhaustion symptoms as well as for cortisol levels and gene expression profiles. At baseline, we found increased basal cortisol levels and an enhanced suppression of plasma cortisol concentrations following dexamethasone in cases suffering from job-related exhaustion. Gene expression analysis revealed that 1.6-fold more transcripts were significantly regulated by dexamethasone in cases as compared to controls. At follow-up after 12 weeks of regular exercise training which was accompanied by significantly improved exhaustion severity scores, cortisol levels and gene expression profiles of cases normalized to the levels observed in controls. In conclusion, we detected GR-induced neuroendocrine and gene expression changes in cases suffering from job-related exhaustion which are in line with an increased sensitivity of GR function. This GR dysregulation normalized with symptom recovery.
    Psychoneuroendocrinology 01/2014; · 5.14 Impact Factor
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    ABSTRACT: Objectives. We tested the hypothesis that sleep training would improve emotional, social and behavioural functioning in children with attention-deficit/hyperactivity disorder (ADHD) compared to children with ADHD without such intervention and to healthy controls. Methods. Forty children with ADHD were randomly assigned to intervention and control conditions. Parents of 20 children with ADHD were instructed and thoroughly supervised in improving their children's sleep schedules and sleep behaviour. Parents of the other 20 children with ADHD and parents of 20 healthy children received general information about sleep hygiene. At baseline and 12 weeks later, parents and children completed questionnaires related to children's sleep and psychological functioning. Results. Relative to the control groups, children in the intervention group improved sleep quantitatively and qualitatively (F values < 3.33, P values < 0.05). The intervention group children reported improvements in mood, emotions, and relationships (F values < 2.99, P values < 0.05). Parents reported that their children improved in physical and psychological wellbeing, mood, emotions, relationships, and social acceptance (F values < 3.02, P values < 0.05). Conclusions. Training and monitoring parents of children with ADHD in regulating and supervising children's sleep schedules leads to positive changes in the emotions, behaviour and social lives of these children.
    The World Journal of Biological Psychiatry 01/2014; · 3.57 Impact Factor
  • International Journal of Psychiatry in Clinical Practice 01/2014; · 0.45 Impact Factor
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    ABSTRACT: The role of physical activity as a factor that protects against stress-related mental disorders is well documented. Nevertheless, there is still a dearth of research using objective measures of physical activity. The present study examines whether objectively assessed vigorous physical activity (VPA) is associated with mental health benefits beyond moderate physical activity (MPA). Particularly, this study examines whether young adults who accomplish the American College of Sports Medicine’s (ACSM) vigorous-intensity exercise recommendations differ from peers below these standards with regard to their level of perceived stress, depressive symptoms, perceived pain, and subjective and objective sleep. A total of 42 undergraduate students (22 women, 20 men; M = 21.24 years, SD = 2.20) volunteered to take part in the study. Stress, pain, depressive symptoms, and subjective sleep were assessed via questionnaire, objective sleep via sleep-EEG assessment, and VPA via actigraphy. Meeting VPA recommendations had mental health benefits beyond MPA. VPA was associated with less stress, pain, subjective sleep complaints and depressive symptoms. Moreover, vigorous exercisers had more favorable objective sleep pattern. Especially, they had increased total sleep time, more stage 4 and REM sleep, more slow wave sleep and a lower percentage of light sleep. Vigorous exercisers also reported fewer mental health problems if exposed to high stress. This study provides evidence that meeting the VPA standards of the ACSM is associated with improved mental health and more successful coping among young people, even compared to those who are meeting or exceeding the requirements for MPA.
    Physiology & Behavior 01/2014; · 3.16 Impact Factor
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    ABSTRACT: Background: The administration of statins seems to be a promising new avenue in the treatment of patients suffering from major depressive disorder (MDD), though patients suffering from severe MDD remain unstudied in this respect. The aim of the present study was therefore to investigate, in a randomized double-blind clinical trial, the influence of adjuvant atorvastatin on symptoms of depression in patients with MDD. Methods: A total of 60 patients suffering from MDD (mean age: 32.25 years; 53% males) received a standard medication of 40mg/d citalopram. Next, patients were randomly assigned either to the atorvastatin group (20mg/d) or to the placebo group. Blood lipid values were assessed at baseline and on completion of the study 12 weeks later. Experts rated depressive symptoms via Hamilton Depression Rating Scales (HDRS) at baseline and 3, 6 and 12 weeks later. Results: HDRS scores decreased over time; the significant Time by Group interaction showed that symptoms of depression decreased more in the atorvastatin than in the placebo group. Compared to the placebo group, in the atorvastatin group cholesterol, triglyceride, and Low Density Lipids (LDL) significantly decreased, and High Density Lipids (HDL) significantly increased over time. HDRS scores and blood lipid values were generally not associated. Conclusions: The pattern of results suggests that adjuvant atorvastatin favorably influences symptoms of depression among patients with severe MDD. Given that after 12 weeks of monotherapy and adjuvant atorvastatin patients were still moderately to severely depressed, more powerful treatment algorithms such as augmentation and change of medication are highly recommended.
    Journal of Psychiatric Research 01/2014; · 4.09 Impact Factor
  • Journal of Health Psychology 01/2014; · 1.22 Impact Factor
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    ABSTRACT: Mental toughness (MT) is understood as the display of confidence, commitment, challenge, and control. Mental toughness is associated with resilience against stress. However, research has not yet focused on the relation between MT and objective sleep. The aim of the present study was therefore to explore the extent to which greater MT is associated with objectively assessed sleep among adolescents. A total of 92 adolescents (35% females; mean age, 18.92 years) completed the Mental Toughness Questionnaire. Participants were split into groups of high and low mental toughness. Objective sleep was recorded via sleep electroencephalograms and subjective sleep was assessed via a questionnaire. Compared with participants with low MT, participants with high MT had higher sleep efficiency, a lower number of awakenings after sleep onset, less light sleep, and more deep sleep. They also reported lower daytime sleepiness. Adolescents reporting higher MT also had objectively better sleep, as recorded via sleep electroencephalograms. A bidirectional association between MT and sleep seems likely; therefore, among adolescence, improving sleep should increase MT, and improving MT should increase sleep.
    Journal of Adolescent Health 01/2014; 54:109-113. · 2.97 Impact Factor
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    ABSTRACT: In a randomized, controlled trial (n = 30), we showed that botulinum toxin injection to the glabellar region produces a marked improvement in the symptoms of major depression. We hypothesized that the mood-lifting effect was mediated by facial feedback mechanisms. Here we assessed if agitation, which may be associated with increased dynamic psychomotor activity of the facial musculature, can predict response to the treatment. To test this hypothesis, we re-analyzed the data of the scales from our previous study on a single item basis and compared the baseline scores in the agitation item (item 9) of the Hamilton Depression Rating Scale (HAM-D) between responders (n = 9) and participants who did not attain response (n = 6) among the recipients of onabotulinumtoxinA (n = 15). Responders had significantly higher item 9 scores at baseline [1.56 + 0.88 vs. 0.33 + 0.52, t (13) = 3.04, d = 1.7, p = 0.01], while no other single item of the HAM-D or the Beck Depression Inventory was associated with treatment response. The agitation score had an overall precision of 78% in predicting response in a receiver operating characteristic (ROC) analysis (area under the curve, AUC = 0.87). These data provide a link between response to botulinum toxin treatment with a psychomotor manifestation of depression and thereby indirect support of the proposed facial feedback mechanism of action. Moreover, it suggests that patients with agitated depression may particularly benefit from botulinum toxin treatment.
    Frontiers in Psychiatry 01/2014; 5:36.
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    ABSTRACT: Background: Allopurinol is a drug used primarily to treat hyperuricemia. In patients suffering from acute mania, increased levels of uric acid are observed, and symptom improvements are associated with decreased levels of uric acid. Accordingly, a purinergic dysfunction is plausibly a causative factor in the pathophysiology of mania. The aim of the present study was therefore to investigating whether allopurinol has benefits for patients treated with sodium valproate during acute mania. Experimental Procedures: A double-blind, placebo-controlled study lasting 4 weeks was performed. The intention-to-treatment population included 57 patients; 50 concluded the study per protocol. Patients suffering from BPD and during acute mania were randomly assigned either to a treatment (sodium valproate 15-20 mg/kg + 300 mg allopurinol twice a day) or to a control condition (sodium valproate 15-20 mg/kg + placebo). Experts rated illness severity and illness improvements (Clinical Global impression), and extent of mania via the Young Mania Rating scale. Uric acid levels were assessed at the beginning and end of the study. Results: Compared to the control group, symptoms of mania decreased significantly over time in the treatment group. Uric acid levels declined significantly in the treatment as compared to the control group. Probability of remission after 4 weeks was 23 times higher in the treatment than the control group. Lower uric acid levels after 4 weeks were associated with symptom improvements. Conclusion: The pattern of results from this double-blind, randomized and placebo-controlled study indicates that adjuvant allopurinol leads to significant improvements in patients suffering from acute mania.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 01/2014; · 3.68 Impact Factor
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    ABSTRACT: The aim of this study was to explore the association between mental toughness, subjective sleep, physical activity, and quality of life during early and mid-adolescence. A total of 1475 participants (mean age = 13.4 years; range: 11-16 years) took part in the study. They completed questionnaires related to mental toughness, physical activity, subjective sleep, and quality of life. Greater mental toughness was related to more favorable quality of life and increased subjective sleep. Mental toughness was not related to physical activity. Increased mental toughness, favorable quality of life, and sleep are related during early and mid-adolescence. Against our expectations, mental toughness was not related to physical activity.
    Journal of Health Psychology 01/2014; · 1.88 Impact Factor
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    ABSTRACT: Objective: The aim of the present study was to exploring to what extent the prevalence of attention deficit hyperactivity disorder (ADHD) in childhood was associated with birth order, gender, and the prevalence of ADHD and mental retardation (MR) in siblings, as compared to healthy controls. Methods: Data from 200 children with diagnosed ADHD (mean age: 11.13 years; 10.5% females) were compared to data from 200 healthy controls (mean age: 11.0 years; 27.5% females). Data were related to symptoms of ADHD, birth order, gender, family size, and the occurrence of ADHD and MR in siblings. Results: Compared to controls, occurrence of ADHD was related to male gender and to the occurrence of ADHD-related symptoms in siblings (odds ratio: 13.50). Birth order and MR were not associated with occurrence of ADHD and ADHD-related symptoms. ADHD-related symptoms increased, if a further sibling suffered also from ADHD. Conclusions: Among a sample of Iranian children suffering from ADHD, child ADHD and ADHD-related symptoms were related to male gender and occurrence of ADHD in siblings. Moreover, birth order was unrelated. The fact that symptoms of ADHD-related symptoms were increased, if a further sibling was suffering from ADHD, and decreased, if a further sibling was suffering from MR, is intriguing and needs further explanations.
    International Journal of Psychiatry in Clinical Practice 01/2014; · 0.45 Impact Factor

Publication Stats

1k Citations
534.25 Total Impact Points

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Institutions

  • 1991–2014
    • Universität Basel
      • Faculty of Medicine
      Bâle, Basel-City, Switzerland
  • 1990–2014
    • Universitäre Psychiatrische Kliniken Basel
      Bâle, Basel-City, Switzerland
  • 2011–2013
    • Tehran University of Medical Sciences
      • Psychiatry and Psychology Research Center
      Teheran, Tehrān, Iran
    • Hamadan University of Medical Sciences
      • Department of Physiology
      Ecbatana, Hamadān, Iran
  • 2012
    • University of Leipzig
      Leipzig, Saxony, Germany
  • 2008
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
  • 2007
    • Philipps University of Marburg
      Marburg, Hesse, Germany
  • 1997
    • Johannes Gutenberg-Universität Mainz
      Mayence, Rheinland-Pfalz, Germany
  • 1991–1996
    • Psychiatrische Universitätsklinik Zürich
      Zürich, Zurich, Switzerland